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Year : 2009  |  Volume : 51  |  Issue : 3  |  Page : 222-224
Postgraduate corner: Continuing medical education: Psychopharmacology

Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India

Click here for correspondence address and email

Date of Web Publication8-Sep-2009

How to cite this article:
Andrade C. Postgraduate corner: Continuing medical education: Psychopharmacology. Indian J Psychiatry 2009;51:222-4

How to cite this URL:
Andrade C. Postgraduate corner: Continuing medical education: Psychopharmacology. Indian J Psychiatry [serial online] 2009 [cited 2021 Jun 14];51:222-4. Available from:

   CME Questions Top

A) Fibromyalgia is a poorly understod syndrome that is characterized by chronic, widespread musculoskeletal and joint pain. There are often multiple tender nodules present in specific anatomical loci, such as over the shoulders and back. Common accompanying symptoms include stiffness, fatigue, mood disturbance, and insomnia. Affected patients suffer from pain-related disability and impaired functioning in everyday life. With this background, mark True or False against each of the following statements:

  1. Escitalopram is an approved treatment for fibromyalgia.
  2. Duloxetine 120mg/day is more effective than duloxetine 60mg/day in the treatment of fibromyalgia.
  3. An adequate trial of duloxetine for fibromyalgia should last at least 4-6 months.
  4. In addition to attenuating measures of pain, duloxetine improves functional outcomes in fibromyalgia.
  5. Fibromyalgia treatments have demonstrated efficacy in long-term as well as short-term management.
B) Tamoxifen is prescribed for various indications to women with estrogen receptor-positive breast cancer. These women may require antidepressant medication for concurrent depression; or for the treatment of hot flushes and other symptoms of artificial menopause. With this background, mark True or False against each of the following statements:

  1. Tamoxifen is metabolized by CYP3A4.
  2. Mirtazapine should be preferred to duloxetine over depressed women who are receiving tamoxifen.
C) Benzodiazepines have anxiolytic and anticonvulsant properties and are cross-tolerant with alcohol. They are therefore prescribed during alcohol withdrawal to reduce the severity of the withdrawal syndrome and to reduce the risk of withdrawal seizures. Diazepam and chlordiazepoxide are traditionally preferred for this indication because both have long half-lives of approximately 1-2 days, each; their levels in blood therefore tend to remain uniform across the course of the day, and drug withdrawal difficulties are fewer. However, they are metabolized by demethylation and hydroxylation and have active metabolites; as a result of these pharmacokinetic properties, they may accumulate, and mask or even precipitate hepatic encephalopathy in patients with alcoholic liver disease. With this background, mark True or False against each of the following statements:

  1. For important theoretical reasons, if alcoholic liver disease is present or suspected, lorazepam should be avoided in patients who are being withdrawn from alcohol.
  2. Clinical data exist to suggest that lorazepam may be effective in the management of uncomplicated alcohol withdrawal.

Click here to view answer. View Answer

   References Top

1.Norregaard J, Volkmann H, Danneskiold-Samsxe B. A randomized controlled trial of citalopram in the treatment of fibromyalgia. Pain 1995;61:445-9.  Back to cited text no. 1    
2.Anderberg UM, Marteinsdottir I, von Knorring L. Citalopram in patients with fibromyalgia: A randomized, double-blind, placebo-controlled study. Eur J Pain 2000;4:27-35.  Back to cited text no. 2  [PUBMED]  
3.Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP Jr, Sharma U et al . A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain 2008;9:792-805.  Back to cited text no. 3    
4.Crofford LJ, Mease PJ, Simpson SL, Young JP Jr, Martin SA, Haig GM et al . Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): A 6-month, double-blind, placebo-controlled trial with pregabalin. Pain 2008;136:419-31.  Back to cited text no. 4    
5.Arnold LM, Pritchett YL, D′Souza DN, Kajdasz DK, Iyengar S, Wernicke JF. Duloxetine for the treatment of fibromyalgia in women: Pooled results from two randomized, placebo-controlled clinical trials. J Womens Health (Larchmt) 2007;16:1145-56.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Russell IJ, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, et al . Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 2008;136:432-44.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Clauw DJ, Mease P, Palmer RH, Gendreau RM, Wang Y. Milnacipran for the treatment of fibromyalgia in adults: A 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial. Clin Ther 2008;30:1988-2004.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Mease PJ, Clauw DJ, Gendreau RM, Rao SG, Kranzler J, Chen W, et al . The efficacy and safety of milnacipran for treatment of fibromyalgia: A randomized, double-blind, placebo-controlled trial. J Rheumatol 2009;36:398-409.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Stahl SM. Fibromyalgia-pathways and neurotransmitters. Hum Psychopharmacol 2009;24:S11-7.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Arnold LM, Rosen A, Pritchett YL, D′Souza DN, Goldstein DJ, Iyengar S, et al . A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain 2005;119:5-15.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Available from: . [last accessed on 2009 Jun 15].   Back to cited text no. 11    
12.Chappell AS, Littlejohn G, Kajdasz DK, Scheinberg M, D′Souza DN, Moldofsky H. A 1-year safety and efficacy study of duloxetine in patients with fibromyalgia. Clin J Pain 2009;25:365-75.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Owen RT. Milnacipran hydrochloride: Its efficacy, safety and tolerability profile in fibromyalgia syndrome. Drugs Today (Barc) 2008;44:653-60.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Henry NL, Stearns V, Flockhart DA, Hayes DF, Riba M. Drug interactions and pharmacogenomics in the treatment of breast cancer and depression. Am J Psychiatry 2008;165:1251-5.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Briest S, Stearns V. Tamoxifen metabolism and its effect on endocrine treatment of breast cancer. Clin Adv Hematol Oncol 2009;7:185-92.  Back to cited text no. 15  [PUBMED]  
16.Available from: xifen-antidepressant_mix_may_raise_cancer_risk.html.]last accessed on 2009 Jun 14].   Back to cited text no. 16    
17.Kumar CN, Andrade C, Murthy P. A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. J Stud Alcohol Drugs 2009;70:457-74.  Back to cited text no. 17  [PUBMED]  [FULLTEXT]
18.Solomon J, Rouck LA, Koepke HH. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome. Clin Ther 1983;6:52-8.  Back to cited text no. 18  [PUBMED]  
19.O′Brien JE, Meyer RE, Thoms DC. Double-blind comparison of lorazepam and diazepam in the treatment of the acute alcohol abstinence abstinence syndrome. Curr Ther Res Clin Exp 1983;34:825-31.  Back to cited text no. 19    
20.Miller WC, McCurdy L. A double-blind comparison of the efficacy and safety of lorazepam and diazepam in the treatment of the acute alcohol withdrawal syndrome. Clin Ther 1984;6:364-71.  Back to cited text no. 20    
21.Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: Effects on symptoms and cognitive recovery. Drug Alcohol Depend 1986;18:329-34.  Back to cited text no. 21  [PUBMED]  

Correspondence Address:
Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5545.55096

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